In the Blink of an Eye

One false step. Bam. A knee collapses. A tendon snaps. A bone shatters. In a split second, an athlete can be sidelined for weeks, months or years. All athletes live with the reality that at any time their athletic careers can be completely transformed.

In early September, the Palo Alto High School varsity football team was midway through an early season practice preparing for Friday's opening game. Running back Tyrell Walker ('10) was readjusting to the Paly football lifestyle after leaving Paly to complete his junior year at another school. Walker looked strong after a few carries, and it seemed that he was on his way to contributing some much-needed depth at running back to the team this year. After taking a fateful pitch, Walker cut outside. As he tried to make a second cut, his smooth footwork faltered and he fell to the turf.

"I was carrying the ball and made a cut," Walker said. "I did a jab step and then I did a plant twist and my knee went the other way."

As Walker limped off the field, it did not seem like this injury would end his Paly career. He would later find out that he had torn his anterior cruciate ligament (ACL), and would have to undergo surgery to repair it.

Before the injury, Walker had high hopes for his future in football. He had plans of pursuing a scholarship to play college football, but now that he is out for his senior year, Walker will either have to pursue football by walking on or attending a junior college.

Walker now faces a two hour operation followed by six months of rehabilitation. He will never play on the Paly football team again.

"It's just devastating," Walker said. "I live and breathe football. I've been playing since I was five years old. I took a whole year off and [now] I come back and get injured."

Situations like Walker's are becoming more and more prevalent among high school level athletes. According to the Center for Disease Control, an estimated 500,000 high school athletes in the United States visit doctors every year for sports related injuries.

"People are so good at sports now that high school players are playing at levels that college players used to play at," San Francisco Giants team surgeon Dr. Gordon Brody said.

Dr. Brody has worked extensively with high school and collegiate athletes.

"They're bigger now, so they are stressing their frame, and they're stressing their tendons and their ligaments and so forth in ways that the body is just not designed to do," Dr. Brody said.

Lying on his couch watching college football, Paly varsity basketball shooting guard Max Schmarzo ('11) is already feeling the mental and physical effects of his surgery from the day before. Schmarzo, the leading three point shooter for Paly's squad last year, started feeling minor knee pain in February of his freshman year. Although he played through two AAU (Amateur Athletic Union) seasons as well as his sophomore year at Paly, the pain increased last spring and he decided to have it checked out by a doctor. Before he knew it, he was wearing a gigantic brace in front of the television, taking four Vicodin a day.

After consulting a doctor, Schmarzo found that he had a bipartite patella in his left knee. This, in effect, meant that his knee cap had separated into two pieces. A bipartite patella is a subtle deformation and many people live their entire lives without knowing that they have one. However, the friction occurring in Schmarzo's knee got to the point where each game became a battle between himself and his knee.

"He'd have to get weaker, because the quad was pulling [on the patella tendon], so if he got stronger, it would actually cause more friction and pain," Bill Schmarzo, Max's father, said.

In order to avoid that situation, Schmarzo decided to have surgery to remove one part of his patella. This will eventually enable him to get stronger and improve his game. Meanwhile, Schmarzo is stuck on the couch waiting to start his rehabilitation.

"It's frustrating to not be able to get myself ready to contribute to the team," Schmarzo said.

This is one of the hardest parts for many athletes who have to have sugery, according to Palo Alto Medical Foundation physical therapist Ed Schiavone.

"It is common for an injured athlete to have feelings of disappointment that they can't participate with the rest of the team, as well as frustration in the length of time needed for an injury to heal or rehabilitation," Schiavone said.

Schmarzo's desire to get back on the court for the second half of the upcoming season fuels his motivation for rehabilitation. Unfortunately, there is no denying the fact that it gets difficult from time to time.

"It sucks to have to sit on the couch all day," Schmarzo said. "I feel so useless. I feel like I'm Jabba the Hutt or something. But you have got to have a positive outlook."

He now faces three to four months of rehab, which will start with walking and lead to more strenuous exercises, such as swimming and lifting weights. Schmarzo hopes to be an impact player once he rejoins the team midseason.

Not all treatment decisions for serious sports injuries are black and white. There are many different types of twists, turns, rotations, dislocations, sprains and fractures that an athlete can suffer. There are often multiple treatment options to help athletes get back to where they need to be in order to compete. And then, of course, they have to take action.

This was the case for varsity volleyball and softball player Kristen Dauler ('10).

Last December, while playing volleyball with her club team, Palo Alto Power, Dauler's knee started to bother her. Unlike many other injuries, Dauler's was not an isolated incident, meaning that the pain occurred because of overuse, not because of one specific trauma to Dauler's knee. She visited a doctor but continued to play through it. The doctor sent her to physical therapy, but, according to Dauler, this did not make a significant difference.

Dauler later tore her patella tendon – the same tendon that caused the friction in Schmarzo's knee. She discussed her treatment options with her parents and doctor. These options included more physical therapy, a Platelet Rich Plasma (PRP) injection, surgery or a combination of the three. She ended up sitting out the last month of the 2009 softball season, and scheduled surgery and a PRP injection for early August of that year.

It is not always clear what kind of surgery will be necessary, or if an athlete even needs surgery at all. Sometimes surgery is optional and can speed up the recovery process. However, there are times when athletes have no choice but to go through with surgery.

"The day I found out I needed surgery was a very emotional day," Dauler said. "I was crying a lot just because I knew my recovery was six months and I would be out for my senior year of volleyball. That was extremely hard."

Dr. Brody has found that adolescent athletes face a lot of frustration immediately following surgery.

Dauler now proceeds to the next stage of the process: rehabilitation.

Throughout rehab, athletes must first regain their range of motion and then focus on strengthening their muscles in order to get back on the field.

"[The] goal of rehabilitation is not only to get the injured body part ready for the demands of sport, but to get the athlete prepared as well," Schiavone said.

This fall, as Dauler goes through her rehab, she decided to stay involved with Paly volleyball, serving as the team manager. She goes to physical therapy each week and does exercises everyday at home to get back to where she needs to be for the softball season.

"My deepest worry is that the surgery isn't successful and I need to have another [surgery] or live with the pain," she said. "But if all goes well, I will be able to do everything I used to do in five months."

Rehabilitation veteran and Paly football alum Sam Tompkins-Jenkins ('09) tore his ACL going into his junior year. Tompkins-Jenkins completed nine months of rehab to prepare for his senior season.

"When you're given exercises to do at home, do all of them," Tompkins-Jenkins said. "Never miss a day because you're only hurting yourself in the end."

Tompkins-Jenkins's experience exemplifies the importance of staying committed to rehabilitation. In order to have the opportunity to return to the field, athletes need to concentrate their efforts to the process.

Now in college, former Paly soccer player Shaina Kaye ('09) still remembers everything about the spring day in 2006 that affected her for most of high school.

"A girl tackled me from behind and I fell," she said. "The bottom half of my leg went one way, my knee went the other way, and the rest is history."

Another ACL injury. Three options.

"It wasn't really a question of whether or not I was going to have surgery because I was so young and I completely ripped my ACL to shreds," Kaye said.

Kaye had the option of using part of her patella tendon, hamstring tendon or a cadaver (a dead person's ligament) to repair the tear. Because of long term problems involved with using the patella tendon and the risk of infection or rejection of a cadaver, Kaye chose to use her own hamstring tendon, which meant a longer rehab period.

Although Kaye's surgery was successful, her recovery process was by no means quick and painless.

"I remember not being able to walk up and down stairs, run, bounce in bouncy houses and [not being able to] just be fun and crazy," Kaye said. "[I could not] do things without having to worry about hurting myself."

In Kaye's case, surgery was the only option. It seems that, as the surgical technology improves and more people undergo operations, more and more athletes are leaning in the direction of having surgery.

"A lot of people want surgery because they see surgery as a miraculous quick fix," Dr. Brody said.

However, many athletes attest that it is anything but a quick fix.

"At the time [following surgery], I really thought that my life sucked and it couldn't get much worse," Kaye said.

Kaye added that being injured and off the field for so long gave her a whole different perspective on being a kid.

"While volunteering at Lucile Packard Children's Hospital [after my surgery], I realized how fortunate I was that my situation was temporary," Kaye said. "And that was the thing, surgery and recovery truly are temporary. It sucks big time while it's happening, but being kids and being so active and resilient, we bounce back really fast."

Even so, Kaye realized the difficulty in regaining confidence in her injured knee toward the end of rehab.

"Learning how to walk again was one of the hardest things I have ever done," Kaye said. "It was so scary putting weight on my leg because I didn't trust the fact that it was strong enough to hold all my body weight."

Despite these challenges, Kaye was able to get past this setback and play soccer during her senior year.

Athletes will always get injured. Some will require surgery and others will not. There is no way to change the physical and mental obstacles that athletes must overcome on their road to recovery.

"I think the greatest challenges that injured athletes face are emotional," Schiavone said. "It is difficult getting over the initial disappointment of not being able to compete, and refocusing their energy."

Most athletes do not know what the physical or emotional impact of their surgery will be, until their operation. When athletes get injured, they have to make their decision and live with it. All athletes take these risks when they step on the field, but in the end they have no control over these sudden career-altering injuries. Some athletes are back on the field making an impact in a few quick months. For others, an injury means much more. <<<